Responding to the opioid crisis

September 12th, 2017

Opioids: A national emergency

Before last year’s presidential election, the Pew Research Center surveyed potential voters on a variety of social issues. Unsurprisingly, researchers found that Trump supporters and Clinton supporters agreed on very little. There was, however, one exception. When asked if they considered drug addiction a “very big problem” in the country today, 56 percent of Clinton supporters and 62 percent of Trump supporters said yes. The survey covered issues from illegal immigration to gun violence to climate change, but the problem of drug abuse was the only area where a majority on both sides agreed.

Substance abuse and drug addiction, particularly opioid addiction, are devastating communities all across the nation. In March of this year, President Trump established the President’s Commission on Combating Drug Addiction and the Opioid Crisis, chaired by New Jersey governor Chris Christie.

At the urging of the commission, Trump announced on August 10 that he would declare the opioid crisis a national emergency. As of this writing, paperwork needed to make this declaration official had not yet been filed, so it’s currently unclear how or when national resources will be used to address the emergency. The need for these resources, however, is beyond dispute. In fact, six states — Alaska, Arizona, Florida, Virginia, Maryland and Massachusetts — have already declared a state of emergency in response to the opioid crisis.

Alarming statistics

According to the President’s Commission and the Centers for Disease Control and Prevention, 142 Americans die every day from a drug overdose, with most deaths related to opioids. Overdoses are now the leading cause of death for persons under 50. The commission stated, “Drug overdoses now kill more people than gun homicides and car crashes combined. In fact, between 1999 and 2015, more than 560,000 people in this country died due to drug overdoses — this is a death toll larger than the entire population of Atlanta.”

According to the American Society of Addiction Medicine (ASAM), in 2015 there were 52,404 lethal drug overdoses, making it the leading cause of accidental death in the United States. Most of those deaths were caused by opioid addiction, with 20,101 related to prescription pain relievers and 12,990 related to heroin.

Opioid prescriptions and harm

The category of opioids includes both legal and illegal drugs. You may be more familiar with the term opiate, which refers to drugs derived from the opium poppy such as morphine, codeine and heroin. Opioid is a more modern term that also includes synthetic versions of opiates such as methadone, oxycodone, hydrocodone and fentanyl. When used in legal painkillers, opioids are often referred to by their brand names, which include Percocet, OxyContin, Vicodin and Lortab. The opioid crisis refers to the use and abuse of all of these drugs, both legal and illegal, synthetic and naturally occurring. Opioids work by interacting with receptors in the brain and nervous system to relieve pain, but they also produce pleasurable side effects. In the 1990s, after receiving assurances from pharmaceutical companies that prescription opioids weren’t addictive, healthcare providers began prescribing them generously and without appropriate warnings. By the time it became clear that these medications were in fact highly addictive, the problem had exploded.

According to the President’s Commission, the increase in the overdose death rate corresponds to the increase in sales of these prescription pain relievers, with both quadrupling since 1999. Although the amount of pain reported by Americans hasn’t changed, the number of people using prescription pain relievers has soared. ASAM reports that in 2012, 259 million prescriptions were written for opioids — enough to give every American adult their own bottle of pills. Most new heroin users start out abusing prescription painkillers, then switch to heroin because it’s cheaper and easier to obtain. As a result, when medical providers tighten access to prescription opioids, some addicts turn to dangerous street versions instead.

Opioid Prescriptions and good

A number of state legislatures are attempting to address the opioid crisis by requiring clinicians to implement restrictions on how and when they hand out painkiller prescriptions. Several states, such as Massachusetts and New York, have passed laws limiting opioid prescription supplies to seven days or less. New Jersey’s law limits the supply to five days and also mandates that doctors create a pain-management treatment plan for patients who require chronic opioid use.

However, those living with chronic pain are concerned about these regulations. They fear an overreaction that will limit access to needed pain relief for overwhelming pain conditions such as rheumatoid arthritis, migraines and severe back pain. The U.S. Pain Foundation, a chronic pain patient advocacy group, states that it’s “committed to protecting access to vital pain management options and preventing pain medication abuse. We believe it is possible to achieve both goals through balanced reform. Unfortunately, many recent reforms at the federal and state level are causing unnecessary suffering for patients with pain.”

On its website, the U.S. Pain Foundation refers to studies showing that most chronic pain patients take opioid medications as prescribed. They counter the belief that opioid addiction starts with a legal prescription and cite research indicating that most abuse comes from medication illegally obtained from a friend, family member or drug dealer. Pain is already undertreated, advocates warn; now they worry that doctors will drop pain patients because of the risk of treating them and because of burdensome reporting requirements.

Faces of addiction and faces of help

Who are opioid addicts? If we’re being honest, we likely envision a homeless person or someone with chronic substance abuse problems. This could not be further from the truth. An opioid addict could just as easily be a college student who became addicted after using pain relievers following surgery or a soccer mom who developed an addiction from pain relievers prescribed for postpregnancy pain. From 1999 to 2010, overdose deaths from prescription painkillers increased more than 400 percent for women, compared to 237 percent for men. While the causes for this difference aren’t completely clear, women are more likely to have chronic pain, be prescribed higher doses of painkillers, and use them for longer periods than men — increasing chances of addiction.

Kent Harshbarger is the coroner in Montgomery County, Ohio, which is now dubbed the overdose capital of America. He estimates that close to 70 percent of the bodies he examines are overdose victims. From January through May of this year, 365 people died of drug overdoses in his county. That’s close to the same amount of deaths for the entire year of 2016. Harshbarger estimates Ohio as a whole will see 10,000 overdoses by year’s end, more than were recorded in the entire United States in 1990.

In response, first responders are now being equipped with Narcan, a nasal spray that can reverse the effects of a drug overdose if administered in time. Even librarians are being trained in the use of Narcan, as overdose cases are found increasingly in public places.

Our prayers are first and foremost with those who are struggling, those who feel hopelessly caught in a cycle of addiction with no way out. However, others are also in need of our prayers and support. Family members and friends can also be trapped in despair, at a loss as to how to help. Coroners, paramedics, counselors, health-care workers, police officers, elected officials and addiction therapists are present on the front lines of this crisis and see the heartbreaking consequences firsthand every single day. They’re struggling to deal with a major health-care emergency with limited resources.

For those who claim hope in Christ and proclaim it as the good news, finding the balance between prayerful contemplation and action is always a challenge. Addictions come in many forms, and we’ve seen many of them up close. An acknowledgement of our deep dependence on God is a crucial first step toward healing and justifying grace.

Be sure to check out FaithLink, a weekly downloadable discussion guide for classes and small groups.

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